Outsmarting perimenopause
Our bodies can change in sneaky ways during the menopause transition, but commonsense lifestyle tweaks can smooth a bumpy path.
- Reviewed by Toni Golen, MD, Editor in Chief, Harvard Women's Health Watch; Editorial Advisory Board Member, Harvard Health Publishing; Contributor
From The Girl's Body Book to What to Expect When You're Expecting, women are flooded with information about puberty and pregnancy. But by the time we reach the third "P" stage — perimenopause — the spigot flow seems to slow to a drip.
Indeed, no alarm bells signal you're beginning the transition to menopause, defined as complete after you've gone 12 consecutive months without a period. And while you've no doubt heard the "highlights" — that you might experience hot flashes, night sweats, and vaginal dryness as menopause approaches — there's more than a small chance that from your early 40s onward, you'll be dealing with an array of head-to-toe symptoms that don't seem to be linked to menopause.
Among the dozens of other troubles that can show up in the four to 10 years before menopause — which happens, on average, at 51 but can take place several years before or after — are anxiety, fatigue, brain fog, joint pain, palpitations, ringing ears, thinning hair, and constipation. It's such a diverse and discombobulating range that connecting the dots to perimenopause can challenge even some clinicians.
But most women also aren't aware they can beat back these symptoms by tweaking diet, exercise, and sleep routines, Harvard experts say. Keeping the status quo no longer works when your body is in flux.
"Even people who may be somewhat prepared for menopause because they've heard about hot flashes or irregular bleeding are often not prepared for the subtle changes that typically predict the bigger changes," says Dr. Jan Shifren, director of the Midlife Women's Health Center at Harvard-affiliated Massachusetts General Hospital.
"Your early 40s is a good time to start being intentional about eating, activity, and sleep, because from this age forward, the consequences of not having decent habits in place can result in a bumpier menopause transition," agrees Hillary Wright, a senior dietitian at Harvard-affiliated Dana-Farber Cancer Institute and co-author of the 2020 book The Menopause Diet Plan.
Alarming weight shifts
One of Wright's perimenopausal patients recently posed a humorous, if fraught, question: "Why am I all of a sudden built like a penguin?" Her musing describes the weight shift many women approaching menopause notice, with more weight stored around the belly than in earlier years.
Even if women manage to dismiss other perimenopause symptoms, weight gain is "the big attention-getter," Wright says. Studies show that women's weight, on average, starts creeping up every year in their 40s and 50s. But "they may not start noticing until they've gained 10 or 15 pounds," Wright says. "They're doing all the same things they've done in the past and now they start gaining weight anyway."
It's difficult to tease apart the effects of menopause from those of aging, however. Just getting older triggers a loss of muscle mass that can slow our metabolism and fuel weight gain.
But so does sedentary behavior. While diminishing estrogen levels cause fat to be redistributed, research suggests inactivity is a better predictor of weight gain and abdominal obesity than aging or menopause is, Wright says.
Renewed exercise push
Women could be doing better to combat these forces. According to the CDC, the proportion of women who meet guidelines for both aerobic exercise and muscle strengthening drops as we get older.
Major health organizations suggest adults get at least 150 minutes of moderate exercise and two sessions of strength training each week. Nearly 23% of women ages 35 to 49 meet these guidelines, but this proportion drops to less than 18% of those ages 50 to 64 and just under 11% of women ages 65 and over.
Regular exercise can cut the number and intensity of hot flashes, according to a 2024 research review published by the journal Nutrients.
"If you're not doing regular exercise and strength training, you're progressively losing muscle mass from your late 30s onward, which affects your tendency to gain weight," Wright says. "This is a time to buckle down on some changes you may have wanted to implement. It's foolish to put it off."
Smart food strategies
Along with renewing their commitment to physical activity, women approaching menopause need to become more intentional about their eating patterns, Harvard experts say. The stark fact is, our changing bodies leave less wiggle room to consume nutrient-poor foods. "As you get into this phase of life and beyond, the calorie margins get narrower than ever," Wright says.
But this era is also an opportunity to implement healthy eating habits that might offset not only perimenopausal symptoms — particularly fatigue and mood shifts — but also lower the risks for chronic conditions such as obesity, cardiovascular disease, diabetes, and osteoporosis, which all become more common with age.
Wright advocates a plant-heavy eating style rich in fruits, vegetables, whole grains, nuts, seeds, and legumes. "Plant-based sources of healthy fats and fiber take more time to digest and metabolize and can help us stay fuller longer," she says.
Protein should also play a major role in your everyday food choices, since it's crucial for maintaining and building muscle as well as sustaining healthy bones. Rich sources include poultry, fish, lean beef, tofu, Greek yogurt, eggs, beans, and nuts, and it's wise to eat protein at every meal and snack.
On top of reassessing what you eat, you should also keep track of when. Be sure to eat at regular intervals during the day instead of putting it off until you're ravenous, when you're less apt to nourish yourself mindfully.
"If you're running around not eating much during the day, it can backfire later, which may have more consequences now than when we were younger," Wright says.
What is diet culture?"You look great! Have you lost weight?" How many times have you said this to a friend or family member over the years? This well-meaning remark is a double-edged sword, however, since it promotes the notion that smaller bodies are inherently more attractive. Such comments are part of "diet culture," a longstanding set of beliefs that prize thinness above other traits and place an artificial moral structure around food choices. Some foods are "bad," while others are "good." And both subtle and overt messaging from many forms of media conflate slimness with health — a fundamentally flawed premise, says Hillary Wright, co-author of the 2020 book The Menopause Diet Plan. "There's a lot of judgment and shame around things that have very little consequence to the big picture," she says. "Individual foods don't turn your health on, like flipping a switch. It's the dietary pattern that matters." Diet culture can also be destructive to both physical and mental health, Wright notes. Overly restricting calories can lead to nutritional deficiencies as well as muscle and bone loss. It can even thwart weight control. She offers these strategies to combat diet culture. Don't label foods as "good" or "bad." "Any kind of foods can fit," Wright says. "It's how you're eating most of the time that counts." Avoid commenting on other people's bodies — or your own. Instead, offer compliments that focus on their character or other traits, such as "I love your sense of humor." Don't rely on social media to govern your sense of health, fitness, or beauty. While you may glean useful information to help optimize your lifestyle, social media sites often spout inaccurate health information. "For everything you read that's going to make you feel better, you're probably going to read two or three things that aren't true or confuse you," Wright says. "Our bodies are pretty good at telling us when we feel good and like what we're doing." |
Optimizing sleep
Sleep is perhaps the third leg of the stool in managing perimenopause symptoms through lifestyle changes. Waxing and waning hormone levels common to perimenopause can make sleep quality unpredictable at best, Dr. Shifren says.
But disrupted sleep can lead to a destructive chain reaction, worsening an array of other symptoms. "You may feel tired, irritable, less patient, and less able to focus at work. You may also feel moodier — a little more anxious and blue," Dr. Shifren says. "People see me with concerns about mood, memory, and cognitive function, but at the end of the day, a lot of that is just due to poor sleep."
Optimal sleep hygiene measures include going to bed and waking at the same times daily; logging at least seven hours of sleep most nights; avoiding screen use before bedtime; and sleeping in a cool, dark room. Ignoring these approaches is no longer an option for many women in their 40s and beyond, Dr. Shifren says.
"Before the menopause transition, you may have had poor sleep habits but slept pretty well anyway," she says. "Now, good sleep habits are even more important because they'll help counteract some of your midlife symptoms."
Image: © Andrew Olney/Getty Images
About the Author
Maureen Salamon, Executive Editor, Harvard Women's Health Watch
About the Reviewer
Toni Golen, MD, Editor in Chief, Harvard Women's Health Watch; Editorial Advisory Board Member, Harvard Health Publishing; Contributor
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